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Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails

Spinal Cord Series and Cases volume 9, Article number: 46 (2023) Cite this article

Subjects

Abstract

Introduction

Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails.

Case presentation

A 21-year-old man with no significant past medical history presented after a high-speed motor vehicle collision with cervicothoracic pain and mild hand grip weakness in addition to numbness of the fourth and fifth digits bilaterally (American Spinal Injury Association Impairment Scale Grade D). Computed tomography imaging revealed spondyloptosis of C7 over T1, a fracture of the C2 vertebral body, and a burst fracture of C3. To relieve spinal cord compression and restore sagittal realignment, closed reduction was attempted, however this resulted in perching of the bilateral C7–T1 facets, leading to an open posterior approach. The patient underwent C7 laminectomy, bilateral C7–T1 facetectomy, and manual reduction using a Mayfield skull clamp followed by C2–T3 fixation. Postoperatively, pain was diminished, sensory disturbances were resolved and the patient was otherwise neurologically stable.

Discussion

There is a role for closed traction for reduction of cervical spondyloptosis, however, its role is debated especially when the patient is predominately neurologically intact. In this setting, the spine surgeon may be required to change traction and operative strategies in order to minimize potentially harmful manipulation while restoring sagittal realignment and stabilizing the spine for preservation of neurological function.

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Fig. 1: Traumatic spondyloptosis of C7 over T1.
Fig. 2: Intraoperative fluoroscopy images.
Fig. 3: Postoperative scoliosis radiographs.
Fig. 4: Postoperative cervical radiographs.

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Data availability

All data generated and analyzed during this study are included in the published article.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Brendan F. Judy, Jovanna A. Tracz, Jordina Rincon-Torroella, A. Karim Ahmed & Timothy F. Witham

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Contributions

Conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: all authors. Drafting the article: BFJ, JAT. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: TFW. Study supervision: TFW.

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Correspondence to Brendan F. Judy or Timothy F. Witham.

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The authors declare no competing interests. Dr. Witham reported being an Advisory Board Member (unpaid) and stockholder from Augmedics and receiving grants from Gordon and Marilyn Macklin Foundation outside the submitted work.

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Ethical approval was not required by the Johns Hopkins Medicine Institutional Review Board, as the presented work is a medical/educational activity that does not meet the Department of Health and Human Services definition of “research”, which is: “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.”

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Judy, B.F., Tracz, J.A., Rincon-Torroella, J. et al. Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails. Spinal Cord Ser Cases 9, 46 (2023). https://doi.org/10.1038/s41394-023-00604-3

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